In September 2023, Rural Health Innovations (RHI) was contracted by the Episcopal Health Foundation (EHF) to conduct a review of the Community Health Access and Rural Transformation (CHART) Community Transformation Track Model design and rollout in Texas. This model introduced restructured financial arrangements for hospitals to utilize operational and regulatory flexibility to realign how they coordinate and provide care to address health disparities. The review by RHI provided an objective assessment of the Texas CHART model awarded by the Centers for Medicare and Medicaid Innovation (CMMI). This review was important due to the discontinuation of the Community Transformation Track by CMMI in 2023 due to a lack of hospital engagement nationally.
RHI’s methodology included a high-level overview of CMMI initiatives in practice in rural communities through a literature review, a review of the Texas CHART Model
transformation plan design and communications with hospitals and partners, and an analysis of the status of Texas hospital finances in 2022. Finally, thirteen key informant interviews were performed to identify the disrupters that impacted CHART adoption in Texas.
RHI identified several policy and education recommendations for consideration in future value-based models with suggestions for state lead organizations and rural providers to prepare and participate. Successful implementation of a rural value-based payment model requires a tiered approach. First models need a rural relevant design on the front end; a trusted state organization for communication, engagement of partners and payors, and technical assistance; and all health care provider types need to participate with knowledge and experience in value-based payment. Health care organizations, especially rural hospitals, need to be ready for change with financial stability, visionary leadership, and a change ready culture with network or system affiliation for the supported infrastructure and risk.
